Working Effectively With Employees who Have Sustained a Brain Injury
What is a Brain Injury?
The brain is a complex organ, the focal point of our capacities to: think; receive, understand language and respond; remember; feel and express emotions; and more. The brain is protected by the bones of the skull and by an intricate system of membranes, fluids and blood vessels. But, like anything else, the brain can be damaged.
Brain injury often results from a trauma to the head and/or brain. Traumatic brain injury can result from a bump to the head or from a force strong enough to cause the brain to bounce against the skull, such as in a motor vehicle crash. Injury can occur even though you don't actually hit your head. Other conditions that can result in a brain injury include: heart attacks, aneurysms, chemical and drug reactions, lung problems, infections, lack of oxygen to the brain, and a variety of other causes. In most cases, an injury sustained as a result of one of these events will result in an increased need for support in the following areas: physical capacities (the way we move and manipulate things); behavioral and emotional capacities (the way we act, tolerate, and feel); and cognitive capacities (the way we think and process information).
A brain injury is different from many other disabilities because the onset of the injury can be traumatic and occur suddenly. Everyday people, like you and your family, are susceptible to brain injury at any time. This brain damage can result in permanent, irreversible damage which can affect tasks and things you have typically done in the past with great ease. There is no cure for brain injury; prevention is the best option for minimizing its occurrence.
Implications of the ADA for Individuals Who Have Sustained a Brain Injury
The Americans with Disabilities Act guarantees the rights of individuals with disabilities. The Employment Provisions (Title I) hold interesting implications for individuals who have sustained a traumatic injury such as a brain injury. In most cases, people who have sustained a brain injury have held employment prior to their injury. Following a period of rehabilitation to increase capacities often effected by the injury, that employee may desire to return to his/her prior position, be reassigned, or develop his/her career path in other ways. For those individuals who sustain a brain injury prior to establishing a work history, the ADA provides the same rights of access to their communities and employment.
If a person who has sustained a brain injury applies for a job with your company, reviewing his/her past education and experience will give you an idea of potential skills and interests. However, regardless of whether a person applying to your company has a brain injury, having previously identified essential job functions will assist you in determining whether or not the individual is qualified, with or without a reasonable accommodation. If an employee sustains a brain injury after having been at work, the same strategies will assist you in determining this person's current qualifications for re-employment. In cases of re-employment, involvement of the employer in the rehabilitation process is critical. You will be able to play a large role, whenever the employee permits your involvement, in assisting the rehabilitation team in knowing exactly what that employee was like prior to his/her injury, what his/her job entailed, and what essential job functions he/she will be required to perform upon returning.
Accommodating an Applicant or Employee Who Has Sustained a Brain Injury
Employee Selection Process:
As in all applicant cases, your main priority, regardless of disability, should be to determine whether an applicant has the necessary skills, experience, education, or other background to successfully perform the essential functions of the job. Your first step is to determine the components involved in applying for, obtaining, and maintaining a job, and being promoted within your company. Once you have clearly identified the different human resources activities an applicant or employee must go through, you will be able to determine possible accomdations along the way which may make the process more accessible for a wider variety of applicants/employees.
However, the reasonable accommodation obligation applies to an individual as the need arises. The ADA does not require you, as an employer, to make general adjustments and modifications for a wide variety of employment situations.
When you advertise an open position, make sure the required qualifications and application directions are stated clearly and concisely. This will assist an individual who may have cognitive support needs in processing the information, allowing him/her to make a clear decision as to whether or not s/he may minimally qualify for the job.
The first rule of thumb when attempting to determine ways to increase the accessibility of human resources policies and practices within your company and accommodate an individual who has sustained a brain injury, is to recognize that not all brain injuries result in the same support needs.
For example...one individual may have no difficulty reading an application form, while another may have a vision problem resulting from his/her brain injury which affects his/her ability to read.
Another example would be a right-handed applicant with limited use of his/her right arm as a result of the brain injury. Some effective strategies may include:
- Allowing the person to complete the application without time constraints;
- Allowing the person to take the application home and have assistance filling it out;
- Mailing the application to the candidate upon request;
- Offering the services of someone in the office to assist in completing it.
Some potentially effective human resources strategies to use when interviewing with an applicant who has sustained a brain injury include:
- Giving clear concise directions;
- If an applicant has requested reasonable accommodation for the interview, asking if s/he has an aide or assistant who might make the interview process more comfortable and aid him/her in presenting his/her skills and qualifications for the job;
- Following up spoken communications (e.g. phone calls, dialogues) with a more permanent record (e.g. letter, audiotape, e-mail) to assist a person who may have memory support needs (e.g. directions, appointment times);
- Making sure your interviewing site is accessible to aid the individual who may have physical support needs resulting from his/her injury.
When you are conducting an interview, be yourself. Disability does not mean inability. Question the candidate with a disability about the same essential job functions as any other applicant. To increase your comfort level and accommodate the potential support needs of the applicant who has sustained a brain injury, be mindful of:
- Finding out support needs prior to the interview (a good time to ask is when setting up the interview, but this assumes that the applicant has disclosed that they have a disability and/or will need an accommodation for the interview);
- Speaking clearly and concisely;
- Repeating a statement that an applicant has told you is unclear or unintelligible;
- Minimizing distractions in the room (e.g., phone calls, interruptions, etc.);
- Doing a walk-through or a tour prior to the interview to make sure the locations involved in the interview are accessible;
- Initially introducing only essential personnel or explaining that s/he will meet quite a few people and it may take some time to get to know them all;
- When explaining tasks or jobs, breaking down each into steps which may be easier to remember or sequence;
- Encouraging the applicant to take notes if desired;
- Avoiding negatives during questioning (e.g. do you instead of don't you; would you instead of wouldn't you, etc.);
- Presenting ideas concretely rather than abstractly;
- Moving on to a new topic if the person seems to be getting frustrated and returning to the original topic later in the interview.
(Remember, not all applicants will need these accommodations. Assuming the applicant has required accommodations, ask the applicant what may assist him/her).
Enhancing Productivity on the Job:
Why do we use a chair to reach dishes on a high shelf? Why do we use automatic pencil sharpeners? Why do we use ergonomically designed office chairs?
Simply put, these adaptations make a task easier and may save time. These are examples of simple accommodations we make to be more productive and ease our workload. Reasonable accommodation is defined as modification or adaptation of a job, employment practice, or work environment that makes it possible for a qualified person with a disability to apply for a job, perform an essential function of the job, or access a benefit of employment. The law states that employers must provide necessary and reasonable accommodations from the first point of contact with a person with a disability, generally the application screening process as well as on the job; in training; on the worksite; and when considering promotions and layoffs. If job duties change, new accommodations may need to be made. The ADA requires an employer to provide reasonable accommodation unless doing so would cause an undue hardship.
If an employer finds that the cost of an accommodation would impose an undue hardship, and no funding is available from another source, an applicant or employee with a disability should be offered the option of paying for the portion of the cost that constitutes an undue hardship, or of providing the accommodation.
Selecting an Accommodation:
The employee candidate who requests an accommodation has lived and perhaps worked while having the disability. He/she may already have identified what accommodations work best for him/her. Given that support needs are individualized based on the severity of a brain injury, so must the accommodation. The process of identifying and selecting an accommodation should be a dialogue between the employee and the employer. The accommodation may be able to be provided using easily identified supports (low tech) or may require the use of more intensified and expensive supports (high tech).
An accommodation for an individual who has sustained a brain injury could potentially include a variety of support strategies such as: memory log books, audiotapes, or other electronic/computer reminders; wheelchair-accessible facilities; job sharing or modified shortened work schedules; job checklists and cues; timers, tools to assist the person in tracking while reading such as a ruler or piece of paper with a window cut in it; smaller job steps to improve sequencing; raised desks or tables to allow for a wheelchair; Telecommunication Device for the Deaf (TDD) if the person has difficulty with speech or hearing; electronic communication systems; ramps; handrails; computer keyboard guards; large phone or computer keypads; changes in lighting or office location to minimize distractions; review of progress on job assignments at designated points in day or week; and established routines during the day and across days. There are also numerous other potential accommodations which might be made depending on the individual's needs.
Tips for On-The-Job Training:
All employees, regardless of disability, need the same introduction and orientation to a job and the same initial training. Determining the learning style of any new employee is a good human resources practice which maximizes the benefits of inservices and training provided. Ask the employee whether s/he learns best from strictly verbal instruction, or a combination style involving hands-on, written, and verbal instruction.
Any new employee has his/her own unique way of setting up a work station or organizing job tasks and supplies. Allowing the employee with a brain injury this flexibility can promote increased performance as long as job quality and quantity is not negatively affected.
In some cases, individuals with more severe disabilities may be represented by a rehabilitation agency or employment program which provides specialized support and technical assistance to employers surrounding the employment of people with disabilities. Although these services can benefit the employer, they should not take the place of internal training, orientation, inservices, and promotional strategies and techniques utilized by your company. The key to successful on-the-job training is integrating, investing, and involving the new employee to the greatest degree possible without stigmatizing the person who may have sustained a brain injury or any other disability.
Resources
There are a number of resources that can assist employers and people who have sustained a brain injury and their prospective employers. If additional information is needed, consult the following organizations:
ADA Regional Disability and Business Technical Assistance Center Hotline - (800) 949-4232 (voice/TTY).
The Equal Employment Opportunity Commission, 1801 L Street, N.W., Washington, DC 20507, Technical Assistance - 800-669-4000 (Voice) 800-669-6820 (TTY). Publications - 800-669-EEOC (Voice) 800-800-3302 (TTY).
Ability Magazine / Jobs Information Business Service, 800/453-JOBS, 11682 Langley, Irvine, California 92714
Provides an electronic "classified" system which allows employers to recruit qualified individuals with disabilities and allows people with disabilities to locate employment opportunities. Their magazine provides information on locating qualified readers, interpreters, personal assistants and assistive devices; on overcoming architectural, communication, and transportation barriers; and on performing job analysis, job modification, and job restructuring.
Association for Persons in Supported Employment (APSE), 800/282-3655, 5001 West Broad Street, Suite 34, Richmond, Virginia 23230
International association which can provide resources and information on how to utilize subsidized "supported employment" programs. Association also provides referral to state chapters which can then provide referral to local supported employment programs in your area.
Job Accommodation Network (JAN), 800/526-7234, West Virginia University, PO Box 6080, Morgantown, West Virginia 26506-6080
Employers talk with Human Factors Consultants about an individual with a disability (not limited to brain injury). The consultant will search JAN's database for information related to the functional requirements of the job, the functional limitations of the employee, environmental factors, etc. The search will provide information about similar situations, names and addresses of appropriate resources.
Brain Injury Association, Inc., 202/296-6443, 105 North Alfred St, Alexandria, VA 22314
Provides informational services and resources on traumatic brain injury. Offers employment-related publications on vocational rehabilitation, job seeking skills, job placement, return-to-work and employment issues, and adaptive work behaviors for victims of brain injury. Local associations can be accessed for local information.
State Vocational Rehabilitation Office
State agency which provides vocational rehabilitation services to individuals with disabilities. Services can include: counseling, advocacy, job training, job placements, and a variety of additional support services including continuing, adult and post-secondary education. For the Office of Vocational Rehabilitation Services in your State, consult a phone directory.
This brochure is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, SPHR, Director, Program on Employment and Disability, School of Industrial and Labor Relations - Extension Division, Cornell University. It was updated in June, 2000 by Stephanie Hanson, Ph.D., College of Health Professions, University of Florida. The original as written by Thomas P. Golden, M.S., Program on Employment and Disability, Cornell University.
Cornell University was funded in the early 1990's by the U.S. Department of Education National Institute on Disability and Rehabilitation Research as a National Materials Development Project on the employment provisions (Title I) of the ADA (Grant #H133D10155). These updates, and the development of new brochures, have been funded by Cornell's Program on Employment and Disability, the Pacific Disability and Business Technical Assistance Center, and other supporters.
Cornell currently serves as the Northeast Disability and Business Technical Assistance Center. Cornell is also conducting employment policy and practices research, examining private and federal sector employer responses to disability civil rights legislation. This research has been funded by the U.S. Department of Education National Institute on Disability and Rehabilitation Research (Grant #H133A70005) and the Presidential Task Force on Employment of Adults with Disabilities.
The full text of this brochure, and others in this series, can be found at: www.ilr.cornell.edu/ped/ada. Research reports relating to employment practices and policies on disability civil rights legislation, are at: www.ilr.cornell.edu/ped/
For further information, contact the Program on Employment and Disability, Cornell University, 102 ILR Extension, Ithaca, New York 14853-3901; 607/255-2906 (Voice), 607/255-2891 (TDD), or 607/255-2763 (Fax).
More information is also available from the ADA Technical Assistance Program and Regional Disability and Business Technical Assistance Centers, (800) 949-4232 (voice/TTY), www.adata.org
Disclaimer
This material was produced by the Program on Employment and Disability, School of Industrial and Labor Relations - Extension Division, Cornell University, and funded by a grant from the National Institute on Disability and Rehabilitation Research (grant #H133D10155). The U.S. Equal Employment Opportunity Commission has reviewed it for accuracy. However, opinions about the Americans with Disabilities Act (ADA) expressed in this material are those of the author, and do not necessarily reflect the viewpoint of the Equal Employment Opportunity Commission or the publisher. The Commission's interpretations of the ADA are reflected in its ADA regulations (29 CFR Part 1630) and its Technical Assistance Manual for Title I of the Act.
Cornell University is authorized by the National Institute on Disability and Rehabilitation Research (NIDRR) to provide information, materials, and technical assistance to individuals and entities that are covered by the Americans with Disabilities Act (ADA). However, you should be aware that NIDRR is not responsible for enforcement of the ADA. The information, materials, and/or technical assistance are intended solely as informal guidance, and are neither a determination of your legal rights or responsibilities under the Act, nor binding on any agency with enforcement responsibility under the ADA.
Working Effectively With Employees Who Have Sustained A Brain Injury
June, 2000 CORNELL UNIVERSITY